Provider Demographics
NPI:1073740486
Name:TRI-CITIES VISION CENTER
Entity Type:Organization
Organization Name:TRI-CITIES VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/BUSINESS MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-585-8314
Mailing Address - Street 1:2720 S QUILLAN ST
Mailing Address - Street 2:VISION CENTER
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-2404
Mailing Address - Country:US
Mailing Address - Phone:509-585-8314
Mailing Address - Fax:509-585-9653
Practice Address - Street 1:2720 S QUILLAN ST
Practice Address - Street 2:VISION CENTER
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99337-2404
Practice Address - Country:US
Practice Address - Phone:509-585-8314
Practice Address - Fax:509-585-9653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-12
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60073002261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center